RESOURCE CENTER

Installation Forms
email download
01.30.2013
Conversion (Renewal) Form
Horizon branded form to be submitted with any renewal request where employer is looking to change benefits, or migrate members from one sub-group to another. Must be submitted with desired renewal quote option.
email download
12.05.2012
Horizon 2013 Cutoff Dates
Listing of possible effective dates for all of 2013 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
email download
05.08.2012
Horizon 2012 Cutoff Dates
Listing of possible effective dates for all of 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
email download
05.03.2012
Confirmation of HSA Funding form (SEH)
REQUIRED form for any new group or conversion adding an HSA plan.
email download
03.28.2012
Small Employer Employee Application (SEH)
Horizon branded Employee enrollment form needed for new business or existing member changes/terminations. Also used for NJ HINT - Dependent to 31 enrollments.
email download
02.15.2012
Horizon 2Q 2012 Cutoff Dates
Listing of possible effective dates thru 2Q 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
email download
12.14.2011
Horizon 1Q 2012 Cutoff Dates
Listing of possible effective dates in 1Q 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
email download
03.29.2011
Horizon Paperwork checklist (SEH)
Horizon branded checklist for new business and conversions. Helpful piece contains small details which are overlooked and will delay processing of case.
email download
03.23.2011
Small Employer Verification form for 2-5 eligible groups (SEH)
Horizon branded form for new business when a 2-5 eligible group does not have tax documentation or payroll
email download
03.23.2011
Small Employer Student Verification guidelines (SEH)
Horizon branded guidelines for their Full-time student verification process
email download
03.23.2011
Small Employer Verification form for Husband/Wife groups (SEH)
Horizon branded form for new business when a H/W only group does not have tax documentation or payroll
email download
03.23.2011
Auto Pay Application form (SEH)
Horizon branded form needed if group wishes to sign up for automatic debit withdrawl for premium payments
email download
03.23.2011
HSA Declaration of Understanding form
Horizon branded form REQUIRED for new business or conversion HSA plans
email download
03.23.2011
Small Employer Waiver form (SEH)
Horizon branded Waiver form for new business and conversions
email download
03.23.2011
Small Employer Group Application (SEH)
Horizon branded Employer application for small group health insurance
Email Document

Email sent successfully!

close
Email Document